HHS’ Thompson: ‘I’ve been able to transform the department’

National Journal staff correspondent Louis Jacobson recently talked with Health and Human Services Secretary Tommy Thompson about his biggest challenges in making the transition from Wisconsin governor to HHS secretary, and his plans for the future. The interview was conducted for a profile of Thompson that appeared in the November issue of World Traveler magazine. An edited transcript follows.

Q. How does your current job compare to being governor?

A. When I was governor, I could have an idea at 3 a.m. -- which I routinely do -- and write it down on the pad next to my bed. I would take it into my office in the morning and have people working on it by 1 p.m. I came to Washington with that mindset and felt that I could do the same thing here.

You have to vet an idea through as many as 12 divisions with 63,000 employees before you can move it forward to get consensus. And after that, it goes to the Office of Management and Budget. They turn you down nine times out of 10 -- because they can and because they want to show you who the boss is. If it gets by them, it goes to the White House, which believes that nothing sacred or original can come from the departments. And if it gets by them, it goes to the president. If it gets the president's support, it goes on to Congress -- and if they ever pass it, it's probably about time for you to retire. That's why there's so much inertia in the federal government to retain the status quo.

But I've been able to transform the department. There had been 12 isolated silos, with their own operating budgets, lawyers, public relations teams, and human resources departments. We have now integrated into one department, which makes us stronger. We have gone from 200 different computer systems to being on the verge of having one. We've gone from 40 personnel offices to four, and we're on the way to one. We have made the department operate like an integrated whole, rather than 12 separate fiefdoms, and as a result, the department is much stronger.

This job is less fun than being governor, but you have such huge issues that affect every man, woman and child in America. This department accounts for 23 cents of every federal dollar -- a budget bigger than the Defense Department. We recognize the tremendous responsibility and opportunity we have to change the health care system for the better, for all Americans. It's an awesome responsibility. With the [Centers for Disease Control and Prevention], the [National Institutes of Health], the largest health insurer [the Centers for Medicare and Medicaid Services], and Head Start, this department has a huge effect.

Q. How has your job at HHS been shaped by 9/11?

A. I think a good part of it has been shaped by the attacks. This department is responsible for biological, radiological and chemical attacks, and for protecting the health of all Americans. When 9/11 came, it was the first time we declared a health emergency -- 11 a.m. that morning.

Since then, we have built a war room across the hall here. We also discovered that we had only 15 million doses of smallpox vaccine. It required a tremendous amount of pushing from me personally in the department to get enough vaccine ready for every man, woman and child in America. We now have the capacity for 400 million doses. We started new programs to purchase anthrax vaccines, and we also put in place an initiative to create a new anthrax vaccine. We set up a new program that's working its way through Congress -- it devotes up to $6 billion for the development of new vaccines for smallpox, anthrax, hemorrhagic fever, botulism, plague and tularemia.

And we purchased 600 tons of medical supplies and equipment, including 20 million doses of antibiotics to take care of 20 million people in 60 days. It's stored at 12 strategic locations, from which we can deliver 50 tons to any city in seven hours. All of this has taken a huge amount of time and resources. We can't prevent an attack, but we can respond very quickly.

Q. How far down the list was bioterrorism when you started this job, before 9/11?

A. At first, it was a concern, because it was an interest of mine as governor. But it was not the overriding concern. I didn't expect it to dominate like it has, even though to me, personally, it was of tremendous interest. I thought America was not very well protected.

Q. What do you consider your biggest projects at HHS?

A. First, transforming the department into one. Second, building a very modern, visionary war room -- an information room to fight bioterror attacks. Third, accumulating enough smallpox vaccine to vaccinate every man, woman and child in America. Fourth, putting in place procedures to acquire additional vaccines for the illnesses I mentioned. Fifth, assisting in the development of the NIH budget. Sixth, prescription drug coverage for Medicare. [Note: the interview was held several months before passage of Medicare legislation.] Seventh, getting a welfare bill to allow for the next generation of welfare recipients. Eighth, the prevention of tobacco use, diabetes and obesity worldwide. Ninth, building maternal and children's clinics in Afghanistan and expanding our international programs to 40-some countries. And 10th, the huge fight against the international and domestic AIDS problem.

Q. What scares you the most?

A. I'm very concerned about the potential for food poisoning, specifically botulinum toxin deliberately being put into the food chain and causing lots of deaths and a huge economic upheaval. We were inspecting only half of one percent of shipments. Now it's close to four percent. We've doubled the food inspectors, but it's not adequate. HHS has the biggest jurisdiction, but we need more resources to do it. It's been neglected in the past, and we're trying to catch up to where we need to be.

Q. How long do you plan to stay in this job?

A. I plan to stay until the president gets re-elected. Then I want to go to the private sector. I would love to run a business. That's my intention.

Q. Will you ever get back into politics?

A. I will never be out of politics. I wouldn't be surprised if I become a candidate for some future office.

Q. What position?

A. No particular position. I had several chances to run for the Senate, but I turned them down. I still think the best elected job of all is governor.

Q. How often do you get back to Wisconsin these days?

A. I get home about once every three weeks now. It used to be once every other week, but recently that has not worked out. My family is in Wisconsin -- I visit them, but they live there. It makes it hard.

Q. What has most surprised you about this job?

A. The most surprising thing to me about the job of being secretary is the complexity of the issues and the size of this mammoth department.

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